EL-16-1975 (3) Miami Shores Village - z PPrma Residential
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Miami Shores,FL 33138-00010050 N.E.2nd Avenue NE
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Phone: (305)795-2204 a 1
Exp iration: 01/161 017h
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Project Address Parcel Number Applicant
370 NE 107 Street 1122310130230
Miami Shores, FL Block: Lot: JOHN GRIFFIN
Owner Information Address Phone Cell
JOHN GRIFFIN 370 NE 107 ST
MIAMI SHORES FL 33161-7175
Contractor(s) Phone Cell Phone LValuatipn: $ 6,000.00
LINDMAR ELECTRIC INC (305)756-1075
�Feet:
Type of Work:REPLACE BRANCH WIRES'UPDATE OUTLET Available Inspections:
Additional Info: Inspection Type:
Classification:Residential Review Electrical
Scanning:3
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
CCF $3.60
DBPR Fee Invoice# EL-7-16-60605
$3.15 07/20/2016 Check#:1912 $ 189.90 $50.00
DCA Fee $3.15
Education Surcharge $1.20 07/15/2016 Check* 1910 $50.00 $0.00
Notary Fee $5.00
Permit Fee-Additions/Alterations $210.00
Scanning Fee $9.00
Technology Fee $4.80
Total: $239.90
In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the plans,drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In
accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are
required for ELECTRICAL,PLUMBING,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work.
OWNERS AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
construction and zoning. Futhermore,I authorize the above-nam for tc d a works d.
July 20,2016
Authorized Signature:Owner / Applicant Contractor / Agent D to
Building Department Copy
July 20,2016 1
Miami Shores Village Ju 5 2016
Building Department '
10050 N.E.2nd Avenue,Miami Shores,Florida 33138
Tel:(305)795-2204 Fax:(305)756-8972 11 11
INSPECTION LINE PHONE NUMBER:(305)762-4949
FBC 20
BUILDING Master Permit No. �'�
PERMIT APPLICATION Sub Permit No.
❑BUILDINGLECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
F-IPLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 3 -7 6 N l I o-14 (1 5 4
City: Miami Shores County: Miami Dade Zip: 3316)
Folio/Parcel#: -Q236
Q236 Is the Building Historically Designated:Yes NO
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Occupancy Type: t f Load: Construction Type: Flood Zone: BFE: FFE:
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OWNER:Name(Fee Simple Titleholder): -1644J C 42 1�f=' Phone#:
Address: 3 -76 14*JF 10-7 -/� k S4
City: M I L)-S -k S V01275 State: PL Zip: 33.//.f
Tenant/Lessee Name: Phone#: 3a5
Email: S0 LEA-CeC: 4 12 6,tAv-,L-CU/--,
CONTRACTOR:Company Name: 2 Phone#
Address: Co. /
City: L ��� C- �� Zip-
State:
Qualifier Name: ,! ,L //Z,� Phone# ,_IC -A0- —/10
State Certification or Registration M C(... OQ;7-I Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#
Address: City: State: Zip:
Value of Work for this Permit:$ D °�' Square/Linear Foota a of Work:
Type of Work: ❑ Addition Alteration F-11New Repair/Replace ❑ Demolition
Description of Work: L✓�/���e p,�,��/� AA ---5 c���� OG o)P24-
Specify color of color thru tile:
Submittal Fee$ Q - � Permit Fee$ f d 80 CCF$ CO/CC$
1
Scanning Fee$ 61, �)b Radon Fee$ � L: DBPR$ "QA, _ otary$
Technology Fee$ '4 o 2 6n� Training/Education Fee$ Double Fee$
Structural Reviews$ Bond$ �l
TOTAL FEE NOW DIE$
(Revised02/24/2014)
Bonding Company's Name(if applicable) v
Bonding Company's Address
City State Zip
Mortgage Lender's Name(if applicable)
Mortgage Lender's Address
City State Zip
Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has
commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating
construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRIC, PLUMBING, SIGNS, POOLS,
FURNACES, BOILERS,HEATERS,TANKS,AIR CONDITIONERS,ETC.....
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all
applicable laws regulating construction and zoning.
"WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY
RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND
TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING
YOUR NOTICE OF COMMENCEMENT."
Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding$2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also,a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. in the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signat Signature ` ` _4ZO W-�NER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
dayy o'f 20 ,by I S day of V 20 by
lei OJIE tli O ,w is personally known two 0�N j CI�IM�I�1yC L�P�vNo.is personally known to
me or who has produced, tr `63% �s me or who has produced( TOO Tz2 WUEN as
identification and who did take an oath. identification and ho did take an oath.
NOTARY PUB C NOTARY PUBLIC:
Sig Sign:
Prin ( tate Print:
ElizabethYelin
Seal `�j� MY Commission FF 063558 Seal:
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APPROVED B) Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
LINDMAR ELECTRIC INC
496 NE 89 STREET
EL PORTAL, FL 33138
July 4, 2016
State of-i—UP—MP1
—5County of MLAMI IC
Before me this day personally appeared0?Jz(\J>U D'Amt'Nu whom being
duly sworn, deposes and says:
That he will the only person working on the project located at �4
Sworn to (or affirmed) and subscribed before me this 119day of " 20 , by
Personally known
OR Produced Identification
Type of Identification Produced :�A— -Oat lA
)o gY°ta Notary Public State of Florida
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s� Miami shores Village
Building Department
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10050 N.E.2nd Avenue
�IORIDp' Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
Notice to Owner - Workers' Compensation Insurance Exemption
Florida Law requires Workers' Compensation insurance coverage under Chapter 440 of the Florida Statutes. Fla. Stat. § 440.05
allows corporate officers in the construction industry to exempt themselves from this requirement for any construction project prior to
obtaining a building permit. Pursuant to the Florida Division of Workers' Compensation Employer Facts Brochure:
An employer in the construction industry who employs one or more part-time or full-time
employees, including the owner,must obtain workers' compensation coverage. Corporate officers
or members of a limited liability company (LLC) in the construction industry may elect to be
exempt if
1. The officer owns at least 10 percent of the stock of the corporation, or in the case of
an LLC,a statement attesting to the minimum 10 percent ownership;
2. The officer is listed as an officer of the corporation in the records of the Florida
Department of State,Division of Corporations;and
3. The corporation is registered and listed as active with the Florida Department of
State,Division of Corporations.
No more than three corporate officers per corporation or limited liability company members are
allowed to be exempt. Construction exemptions are valid for a period of two years or until a
voluntary revocation is filed or the exemption is revoked by the Division.
Your contractor is requesting a permit under this workers' compensation exemption and has acknowledge that he or she will not use
day labor,part-time employees or subcontractors for your project.The contractor has provided an affidavit stating that he or she will
be the only person allowed to work on your project.In these circumstances,Miami Shores Village does not require verification of
workers' compensation insurance coverage from the contractor's company for day labor,part-time employees or subcontractors.
BY SIGNING BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS
CONTENTS.
Signatur
Owner
l
State of Florida
County of Miami-Dade
The foregoing was acknowledge before me this day of ' �� ,20A�_.
By ljkf1 Y, Y 1 i Y1 who is personally known to me or has produced
as identification.
Notary:
YANADYPRIErO
SEAL: ;.; +: MY COMMISSION#FF 214031
:0. EXPIRES:March 25,2019
Bowled Thru Notary Public Undarwritarc